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The Kaiser Way: Lesson for U.S. health care?

The Affordable Care Act has been changing the way most hospitals do business, forcing them to rethink their emergency room visits and admit fewer people with questionable ailments. For Kaiser Permanente, a

The Affordable Care Act has been dramatically changing the way hospitals do business, forcing them to rethink which patients they admit and focus on keeping people healthy.

For Kaiser Permanente, however, it's been largely business as usual, says CEO Bernard Tyson, who took the helm a year ago.

Kaiser is a fully integrated hospital-doctor-insurance company, kind of an "accountable care organization" on steroids. ACOs are networks of doctors and hospitals that share financial and medical responsibility for patients' care — exactly what the ACA encourages with Medicare, using bonuses for efficient and effective health care.

So does the ACA mean we're in for the Kaiser-fication of health care — or should be?

Health care economist Paul Ginsburg is skeptical.

As a closed network with a completely integrated insurance company and the medical group, "Kaiser is a very unique system " says Ginsburg. "It's not as if other physicians and the system is going to head Kaiser's way."

But if they did, Ginsburg doesn't think it would be all bad.

Although some doctors and labor groups grumble that Kaiser offers inferior care, "People now talk with great respect about Kaiser in California," where the company is based, says Ginsburg, a professor at the University of Southern California.

"Kaiser is the competitor that causes the most concern," says Ginsburg, who founded the Center for Studying Health System Change and was the first director of what is now the Medicare Payment Advisory Commission.

In an interview, Tyson says Kaiser's focus on affordability, technology, electronic health records and healing is something that all hospitals could learn from to meet the ACA's provisions.

Unlike hospitals that lose money when they discharge patients, Kaiser, as the insurer, saves money when it reduces the length of hospital stays. Traditional hospitals' "incentives are not aligned with efficiencies," he says.

Through technology and having 9.5 million patients on electronic health records, Kaiser can quickly diagnose and treat patients in the hospital and then transfer them to rehabilitation or outpatient facilities.

Other U.S. doctors and hospitals may not be becoming Kaiser, but more are joining forces in ACOs to save money and increase efficiency.

Pittsburgh cardiologist Dean Kross finds that worrisome.

"ACOs are reincarnations of HMOs of the '80s and '90s, which were abusive to patients by depriving them of needed care, in the interests of profits for the company," he says.

Kross, who uses several companies' electronic health record systems, also worries that an embrace of systems like Kaiser's can carry risks. He is among the physicians who question whether there's evidence to prove that electronic record systems save money and improve medical outcomes for patients.

"By relying on electronic health records and ordering systems to manage the entirety of patient care, hospitals are using medical devices that have not been subjected to scrutiny for safety, efficacy and usability as the FDA requires of all other medical devices," Kross says.

Kaiser has struggled to implement its model outside of its home base of California, Ginsburg notes. Last year, it sold its Ohio organization to Catholic Health Partners and has only opened hospitals in two other states — Oregon and Hawaii. Still, the company is expanding in new ways both in and outside of the state and has members in eight states and Washington, D.C.

The company opened a new state-of the-art hospital in Oakland in June, dramatically overhauling a 60-year-old hospital with high-tech features, including advanced imaging technology for brain surgery and interactive boards for patients to communicate with nurses and doctors.

Last week, Kaiser announced a new partnership with Johns Hopkins Medicine in Maryland that includes sharing electronic records and developing a technology-oriented home health care program. Kaiser members in the Mid-Atlantic already use smartphones, laptops and tablets with cameras to connect with their doctors through video conferencing from home. Kaiser doctors already work out of Hopkins' Suburban Hospital in Bethesda, Md.

"The philosophy we employ in our hospitals (has) changed over the years and should, in fact, be considered by the industry," says Tyson.